Issue - Southern Medical Association

Editorial

WEARING OUT

Original Article

Fiberoptic Colonoscopic Examination in Surgical Patients With Colorectal Cancer

A diagnostic and surveillance program using colonoscopy in patients with colorectal cancer was established at North Carolina Memorial Hospital. The records of all patients who had preoperative or postoperative colonoscopic examination between 1976 and 1979 were reviewed. Fifty-five patients had colonoscopic examination preoperatively. No additional disease was found in 39….

Original Article

Tuberous Sclerosis Presenting as Chronic Renal Failure

A patient with tuberous sclerosis presented with cutaneous lesions and chronic renal failure from multiple renal angipmyolipomas and diffuse renal cystic disease, but without apparent significant neurologic involvement. The clinical and pathologic features of tuberous sclerosis, as well as diagnostic and therapeutic procedures useful in this disorder, are reviewed with…

Announcement

GENERAL ANNOUCEMENTS

Original Article

Acute Febrile Juvenile Rheumatoid Arthritis in Adults Cause of Polyarthritis and Fever

Acute febrile juvenile rheumatoid arthritis (JRA) of adult onset is often diagnosed by ruling out other problems. The classification of JRA is primarily based on the distinct type of onset, of which there are usually three: (1) acute febrile or StillS type, (2) polyarticular, and (3) mono-articular pauciarticular arthritis. Fever…

Original Article

Peer Review in Diabetes and Hypertension The Relationship Between Care Process and Patient Outcome

To assess the effect of physician performance on patient outcomes, we examined the relationship between performance of essential care items and several patient outcomes in hypertension and diabetes. A group of internists in private practice selected the criteria and allowed their records to be reviewed to ascertain their adherence to…

Original Article

Clinical Experience With a New Casting Tape

Between October 1977 and June 1978, 93 CutterCast* casts were applied at the Veterans Administration Hospital in Atlanta, Georgia. The composition and application of this new casting system are described, and the performance of the 93 casts is evaluated in relation to ease of application, roentgenographic clarity, skin condition, patient…

Original Article

Atrioventricular and Intraventricular Conduction Disturbances in Aortic Valvular Disease

Electrophysiologic studies of His bundle were done on 32 consecutive patients with symptomatic aortic valvular disease. Nineteen had pure aortic regurgitation and 13 had aortic stenosis, four with significant regurgitation. Fifteen of the former had atrioventricular (AV) and/or intraventricular (IV) conduction abnormalities. In those with aortic stenosis, eight had conduction…

Original Article

Resection of Abdominal Aortic Aneurysms in the Over-80 Age Group

We reviewed the risk of resecting an abdominal aortic aneurysm in 38 patients aged 80 years or older. The operative mortality for an elective aneurysm was 5.2%, for symptomatic but nonruptured aneurysm 26.6%, and for ruptured aneurysm 66.7%. The preoperative risk factors were essentially the same for the elective and…

Original Article

Bacterial Endocarditis With Aortic Regurgitation Implications of Embolism

We studied 16 patients with 18 episodes of bacterial endocarditis and aortic regurgitation to learn the frequency and characteristics of systemic embolism. Seven patients had eight episodes of clinically apparent emboli, with a mortality of 43%; in those without emboli there was no mortality. The influences of congestive heart failure,…

Original Article

Acute Renal Failure Associated With Indomethacin Administration

Two patients had transient deterioration of renal function during acute infectious states while receiving indomethacin. Neither patient was in septic shock; renal function deteriorated at a time when clinically the infection was improving and both patients improved when indomethacin was discontinued, with return of renal function to baseline. Indomethacin inhibits…

Original Article

Prospective Study of Congenital Cytomegalovirus Infection

The overall incidence of neonates with urinary cytomegalovirus (CMV) excretion was 0.9% of 954 tested. The incidence was twice as high in the lower as in the upper socioeconomic group (SEG). Mothers of infants with CMV infection in the lower SEG reported a greater number of chronic and gestational medical…

Original Article

Testalgia Associated With Rubella Infection

Investigation of an outbreak of rubella on a college campus provided an opportunity to study the occurrence of orchids, or testalgia, in male adolescents and young adults. Of 68 subjects with rubella infection, five reported pain without swelling in one or both testicles lasting up to three days. Two of…

Original Article

Ultrasonography and Focal Vascular Disease

The major vascular structures in the retroperitoneum are valuable landmarks for the ultrasonographer. Two cases of focal disease, one involving the pancreatic region (an aneurysm of the superior mesenteric artery) and another involving the kidney (a renal arteriovenous fistula) are presented to emphasize the importance of considering a vascular origin…

Original Article

Etiologic Factors of the Stevens-Johnson Syndrome

We present a retrospective analysis of etiologic factors in 54 cases of Stevens-Johnson syndrome (SJS) diagnosed at Johns Hopkins (1966 to 1976). Our previous study, completed there in 1965, served as a model and data base for comparison. Analysis of the clinical presentation and epidemiologic data in this study reveals…

Original Article

Spontaneous Intestinal Perforation in SchüUnlein-Henoch Purpura

SchüUnlein-Henoch purpura (SHP) continues to present diagnostic and therapeutic challenges to internists and to surgeons. Indications for operation in this entity are solely for intussusception, ischemic bowel necrosis, and frank bowel perforation. We present two recent cases of spontaneous small bowel perforation in SHP and analyze the previously reported cases….

Original Article

Clinical Studies of a Large Family With WilsonS Disease

We have identified 11 individuals with Wilsons disease, members of five sibships within a larger family which was traced through seven generations. Of 206 other family members evaluated for Wilsons disease, none had abnormally low serum ceruloplasmin or copper levels and none had Wilsons disease. There were two documented instances…

Original Article

Evaluating Candidates for Ventricular Aneurysmectomy

Forty consecutive patients having left ventricular (LV) aneurysmectomy were evaluated for surgical risk predictors and were then followed up after operation. Factors evaluated included age, time since last myocardial infarction, NYHA classification, principal indication for surgery, LV end diastolic pressure, LV “A” wave size, number of coronary systems with >70%…

Original Article

Decompression Without Synovectomy in Rheumatoid Extensor Tenosynovitis

Fifteen wrists in 11 patients with rheumatoid tenosynovitis involving the extensor tendons were treated by decompression alone, without synovectomy. The results were not unlike those obtained by the more traditional operation of tenosynovectomy. Alleviation of the retinacular compression appears to have a beneficial local effect to reduce synovitis and to…

Original Article

Neurofibromatosis, Hypertension, and Renal Artery Aneurysms

A case of bilateral renal artery stenosis and aneurysms in association with neurofibromatosis and hypertension is discussed and the literature is reviewed. In patients with neurofibromatosis and hypertension, the association of pheochromocytomas is well known. The association of renal vascular lesions must also be recognized. In children with neurofibromatosis and…

Review Article

Carcinoid Disease

We reviewed 28 cases of carcinoid tumor arising in the small intestine (11 cases), appendix (eight), rectum (three), and lung (six), which were diagnosed during a ten-year period ending in 1977. Components of the carcinoid syndrome occurred in only three patients, all of whom had hepatic metastases from tumors of…

Current Concepts

Approach to the Management of Fever and Granulocytopenia

In recent years, advances in chemotherapy for malignant disease have resulted in a greater population of patients with granulocytopenia whose course is often complicated by fever. We reviewed the current medical literature in an attempt to identify the most appropriate management of this special patient population. Our findings suggest that…

Article

The Hospice Movement in North America

Abstract

Fulminant Cushings Syndrome With Diarrhea

Case Report

Esthesioneuroblastoma Presenting as an Intracranial Mass

Case Report

Granular Cell Myoblastoma of the Bronchus

Case Report

Metastatic Basal Cell Carcinoma of the Lung

Case Report

Pyomyositis Diagnosed by Radionuclide Imaging and Ultrasonography

Case Report

Villous Adenoma of the Duodenum With Intussusception

Case Report

Oral Labetalol in the Management of the Sympathetic Overactivity of Severe Tetanus

Case Report

Pseudomesotheliomatous Carcinoma of the Lung

Case Report

Renal Scleroderma Comparison of Different Modalities of Treatment

Case Report

Pulmonary Nocardiosis Presenting as a Bronchogenic Tumor

Case Report

Left Ventricular Lipoma Echocardiographic and Angiographic Features

Case Report

Ultrasonography of Renal Cell Carcinoma Adjacent to a Renal Cyst

Case Report

Severe Pulmonary Hypertension With Patent Ductus Arteriosus

Case Report

Mediastinal Extramedullary Plasmacytoma

Case Report

Eosinophilic Infiltration of the Stomach

Case Report

Thrombotic Thrombocytopenic Purpura After a Dogbite

Case Report

Primary Adenosquamous Carcinoma of the Fallopian Tube

Clinical Brief

Rapid In Vivo Bone Mineral Analysis After Parathyroidectomy

Brief Review

Histoplasma capsulatum Endocarditis Requiring Aortic Valve Replacement for Aortic Insufficiency

Brief Review

Epidermoid Cyst of the Testis

Brief Review

Dexamethasone-Inhibited Pertechnetate Uptake in Metastatic Carcinoma of the Cerebellum

Brief Review

Melioidosis Reactivation During Radiation Therapy

Brief Review

Recurrent Arteriotracheal Fistula

Editorial

CARE OF THE ELDERLY

Editorial

NONCARE OF THE ELDERLY

Primary Article

Hip and Knee Flexion Contracture After Poliomyelitis

New cases of acute poliomyelitis continue to occur in many areas of the world and are often followed by the development of hip and knee flexion contractures in those who survive. Thorough understanding of the anatomy of the fascia lata and iliotibial band, and of the pathology involved in their…

Primary Article

Early Ischial Weight-Bearing Cast Brace for Femoral Fractures

Three patients with middle or distal femoral fracture were treated with modified ischial weight-bearing cast incorporating only the thigh. The treatment provided adequate stabilization, allowed early ambulation, and promoted fracture healing.

Primary Article

GENERAL ANNOUNCEMENTS

Primary Article

Congenital Absence of the Radius

We review the experience in treating congenital absence of the radius at Shriners Hospital in Shreveport. The prognosis for hand function in patients treated nonoperatively is poor to fair, while a minority of patients have good function after operative treatment.

Primary Article

Synovectomy of the Elbow and Excision of the Radial Head in Rheumatoid Arthritis

Twenty-two patients with rheumatoid arthritis who had partial synovectomy and excision of the radial head were reviewed at an average of five years and four months after operation. Of these, 84% obtained satisfactory pain relief and 76% had improved range of motion postoperatively. Eighty-eight percent were satisfied with the final…

Primary Article

Evaluation of Lead, Zinc, and Copper Excretion in Chronic Moonshine Drinkers

To assess the usefulness of various routine and inexpensive tests widely used in the detection of an increased body lead load, the whole blood lead value, the 24-hour urinary excretion of lead, delta-aminolevulinic acid (DALA) and coproporphyrin, the presence of basophilic stippling and the whole blood osmotic fragility test were…

Primary Article

Computerized Tomographic Evidence of Cerebral Atrophy in Heavy Drinkers

Of 50 heavy drinkers referred for nonalcoholic psychiatric problems, 56% had computerized tomographic evidence of cerebral atrophy. This contrasted with a rate of 6% in patients with schizophrenia and affective illnesses who had taken psychotropic drugs for at least ten years. Further, the severity of atrophy was greater in the…

Primary Article

Bacteremia Related to IV Cannulation Variability of Underlying Venous Infection

During 1977, 22 of 66 cases of nosocomial bacteremia in our hospital were directly or indirectly attributable to infection from the intravenous (IV) site. IV-site-related bacteremia (IVSRB) occurred most frequently in patients with serious underlying disease. The characteristic clinical picture was one of fever, tachycardia, and hypotension. Signs at the…

Primary Article

Religious Life of Alcoholics

It has been documented that alcoholics often become abstinent after a religious experience. We have inquired into the religious teachings, beliefs, practices, and experiences of a group of chronic alcoholics. It was observed that alcoholics were less involved in religious practices, had less exposure to religious teachings, had fewer religious…

Primary Article

Fireworks Blindness A Cooperative Study of Arkansas Ophthalmologists and Review of Fireworks Regulation in the South

Through a cooperative study, 87 ocular injuries caused by class C fireworks have been recorded in the State of Arkansas over a four-year period. The most common injuries were corneal abrasion, lid laceration or burn, and hyphema. Rockets and firecrackers caused 80% of the injuries. In over half the cases…

Primary Article

Appendicitis With Perforation A Reminder to Internists

Over a two-year period, four adults with appendicitis were admitted to the medical service with manifestations sufficiently atypical to obscure the correct diagnosis. Perforation of the appendix was found in each, and abscess formation occurred in two cases. One patient died. The experience with these cases reemphasizes the protean manifestations…

Primary Article

Postoperative Appendicitis

Appendicitis developed in three patients during the postoperative period. At reoperation, perforation of the appendix occurred in all three instances and abscess was present in two. The postoperative status caused confusion in the diagnosis and led to inappropriate delay in operation. Failure to recognize appendicitis in the postoperative period suggests…

Primary Article

Phycomycosis A Cause of Bronchial Obstruction

A patient with diabetes mellitus presented with an obstructing mycetoma in the right bronchus intermedius due to Phycomycetes. Review of the literature revealed eight prior case reports of patients with prominent endobronchial disease attributable to phycomycosis. Indolent, obstructing lesions in large bronchi were noted in diabetics. The clinical illness differed…

Primary Article

Venom Yield of the North American Coral Snake and its Clinical Significance

The dry venom yields of 14 North American coral snakes were measured and correlated to the length of the individual snake. There exists a positive linear correlation between the length of the snake and the amount of dried venom elaborated. The results of this experiment show that the North American…

Primary Article

Modular Approach to CPR Training

Basic and advanced cardiopulmonary resuscitation training is worthwhile yet time consuming. Anesthesiologists should be among the most qualified leaders in CPR teaching programs. Using a modular self-teaching presentation for basic and advanced cardiac life support courses, minimal instructor time is required to accomplish proficiency in both didactic and mannequin performance…

Primary Article

Neutropenia Induced by Semisynthetic Penicillin

The semisynthetic penicillins, like the parent drug penicillin G, are remarkably safe drugs. However, a significant number of patients have been reported in whom profound neutropenia has developed. This is a side effect of these drugs not appreciated by a significant number of physicians. I report two more cases of…

Primary Article

Dirofilaria immitis A Zoonosis of Clinical Concern

Dirofilaria immitis, the dog heartworm, is responsible for an endemic zoonosis in the Southeastern United States. The nematode is capable of infesting the lungs of man, causing pulmonary nodules. The epidemiologic, morphologic, and clinical features of D immitis infestation are discussed.

Primary Article

Infectious Complications in Renal Transplant Recipients

Infections complicated the course of 59 of 111 renal transplantations (53%) performed on 93 patients at the University of Maryland Hospital. Infections and resultant deaths were more common among the patients with cadaver transplants. The transplant wound and the urinary tract were the most common sites of infection, occurring in…

Primary Article

Communication Between Cancer Patients and Physicians

A total of 185 practicing physicians in middle Tennessee responded to a questionnaire regarding their communication patterns with cancer patients. This represented 61% of a total of 320 area physicians to whom questionnaires were mailed. Nearly 98% of responding physicians always or usually inform patients that they have cancer. No…

Primary Article

Carcinoma of the Penis

Thirty-five patients with carcinoma of the penis were treated at the teaching hospitals of West Virginia University Medical Center during the last 15 years. All cases were epidermoid carcinoma except for one case of melanoma. Factors adversely affecting prognosis were (1) the presence of clinically palpable lymph nodes, (2) age…

Primary Article

Bronchoscopic Detection of Bronchogenic Carcinoma in Cases of Pneumonia

This study was undertaken to determine what factors would be useful in making a decision to do bronchoscopy to look for an obstructing carcinoma in cases of pneumonia. The study showed that in pneumonia limited to one lobe of the lung, which occurs in a heavy smoker over 50 years…

Primary Article

Psychiatric Diagnosis in Family Practice Is the General Health Questionnaire an Effective Screening Instrument?

The General Health Questionnaire has been considered an effective screening instrument in a family practice population. To evaluate its efficiency in identifying psychologic distress, 1,000 consecutive attenders at the Family Practice Clinic were given the 30 item GHQ. Of the patients from the sample, 33% were identified by the GHQ…

Grand Rounds

Blisters Can Be Dangerous

Review Article

Scleroderma I Developments From Osier to the Present

The clinical entity of progressive systemic sclerosis (PSS, or scleroderma) has remained unchanged since Osiers first description in 1892. Several related or overlap syndromes have now been recognized, which may afford some insight into etiologic events in the development of PSS. As yet, the cause of PSS remains elusive. Abnormalities…

Current Concepts

Diagnosis and Management of Hysteria

Patients with the diagnosis of hysteria are a perennial management problem for the nonpsychiatric physician. Hysteria is an operationally defined clinical entity characterized by onset before age 30 and by multiple medically unexplainable symptoms. Such patients should be differentiated from those with psychiatric disorders resulting in somatization, especially conversion disorders,…

Article

Relocating Primary Care Patients From Tertiary Hospital to Neighborhood Health Centers

A national commission recently recommended that public general hospitals assume the initiative in arranging neighborhood-based primary care. A survey of medically underserved census tracts conducted in Houston 11 years ago revealed that 80% of residents interviewed stated that if neighborhood clinics were developed they would use them. After ten years…

Brief Review

Electrical Alternans in Supraventricular Tachycardia

Brief Review

Compensated Thrombocytolytic State

Brief Review

Left Atrial Thrombus Despite Anticoagulant Therapy in a Patient With a Mitral Valve Prosthesis

Brief Review

Intrahepatic Gallbladder

Brief Review

Acute Massive Unilateral Hydrothorax A Rare Complication of Chronic Peritoneal Dialysis

Brief Review

Temporal Arteritis in a Black Patient

Brief Review

Large Ovarian Cyst Simulating Urinary Bladder on Ultrasonography

Brief Review

Perforated Duodenal Diverticulitis

Brief Review

Intestinal Obstruction Caused by a Uterine Leiomyoma

Brief Review

Factitious Trophoblastic Disease Münchausens Mole